Some Communities Make Progress in Reducing Children's Uninsurance

Originally published as Data Bulletin No. 19 by the Center for Studying Health System Change (HSC), October 2000. HSC was a nonpartisan policy research organization funded principally by the Robert Wood Johnson Foundation.

Some Communities Make Progress in Reducing Children's Uninsurance

Although national rates of uninsurance among children did not change significantly between surveys conducted in 1996-1997 and 1998-1999, several communities saw meaningful declines during this period, according to findings from the Center for Studying Health System Change. Children's uninsurance rates dropped from 7 percent to 3 percent in Boston, from 17 percent to 12 percent in Little Rock, and from 7 percent to 4 percent in Syracuse. Declines also occurred in Miami, Greenville, and Cleveland, though those changes did not reach statistical significance.

Economic Factors

The strong economic growth of the late 1990s likely contributed to the reductions in some communities. The connection was particularly clear in Boston, where the decrease in children's uninsurance was driven almost entirely by an increase in private insurance coverage. Private coverage is closely tied to family income, and Household Survey data showed significant income gains among Boston families with children between the two surveys, along with a decline in the share of children living below the poverty line -- from 16 percent in 1996-1997 to 10 percent in 1998-1999. A separate report on health insurance in Massachusetts cited the strong economy and private sector as key forces behind sharp statewide declines in children's uninsurance.

Public Coverage Expansions

Expansions of public coverage -- particularly Medicaid and the State Children's Health Insurance Program (SCHIP) -- also played a role in the communities that experienced the greatest improvements. Massachusetts, New York, and Arkansas were cited as being among the most successful states in enrolling children in these programs. However, eligibility expansions did not automatically translate into coverage gains. In Northern New Jersey and Orange County, California, eligibility standards were broadened without a noticeable impact on children's uninsurance rates. In Greenville, increases in public coverage were largely offset by declines in private insurance, producing little net improvement -- a pattern that mirrored what HSC had observed nationally among low-income children.

Policy Implications

U.S. Census Bureau data indicated that children's uninsurance rates had declined nationally for the first time after a decade of steady increases. This Data Bulletin showed the gains were concentrated in certain communities. Some, including Boston, Lansing, and Syracuse, were approaching near-universal coverage of children, while others had made significant inroads into what had been a major local problem. Still, considerable variation persisted across communities. Some areas with high uninsurance rates had made little progress despite substantial eligibility expansions, and it remained unclear whether these communities could replicate the success seen elsewhere. HSC planned to continue monitoring these trends and investigating the economic and policy factors behind the divergent outcomes.

Sources and Further Reading

HSC Community Tracking Study Household Survey, 1996-1997 and 1998-1999. | Park, Michael H., and Peter J. Cunningham, Data Bulletin No. 19, Center for Studying Health System Change, October 2000. | U.S. Census Bureau, Health Insurance Coverage 1999, September 2000. | Edmunds, M., M. Teitelbaum, and C. Gleason, All Over the Map: A Progress Report on the State Children's Health Insurance Program, Children's Defense Fund, July 2000.